If a patient wants to raise their nasal tip in revision rhinoplasty, can a columnella strut be sufficient?

Question

If a tip is droopy, can a tip be raised with rotation techniques and a columella strut alone (instead of adding lots of bulk & changing the shape of the tip w/tip grafts, shield grafts, ear cartilage, and so on)? Or is more grafting required to preserve breathing once a tip is rotated? #droopy tip #columnella strut #grafts #bulk

Tanveer Janjua, MD · Answer

It is always best to do the least amount of surgery to get the best possible result.  A columellar strut alone with some rotation techniques can achieve elevation of the nasal tip.RegardsDr. J

Steven M. Denenberg, MD · Answer

You keep asking these good technical questions.Remember me, the heretic? A columellar strut does nothing to elevate the tip of the nose. Picture a nose with a drooping tip. Now imagine that same nose with the addition of a columellar strut. What happened to lift the tip? Answer: nothing.There is nothing magical or anti-gravity about a columellar strut. The columellar strut doesn't pull anything up; it just sits there, between the medial crura in the columella.If you want the tip to come up, you usually have to do something with the tip cartilages, especially the lateral crura. Something complicated, evidently, since I see so many revision rhinoplasty patients who had inadequate elevation of the tip in their primary operation.Similarly, tip grafts and shield grafts don't elevate the tip by themselves. In fact, a shield graft, sitting just below the tip, would by itself make the tip look droopier.You don't add bulk to rotate the tip up. Rather you reduce bulk.What happens with the breathing is also complicated, but often, just the fact that the tip is elevated helps the breathing, because the air has a straighter flow path to get inside the nose.You know, if you post or send some photos, I could make some morphs, and show the amount of improvement I think could be possible. Ultimately, if you have surgery, the surgeon will use whatever techniques *he* thinks are best. You pick the surgeon by looking at his results and making a rational choice, but you don't get to dictate the techniques that he uses. In fact, if you like his results, you *should* trust him to use those techniques that he's happy with to create for you a nice nose like the other results you've seen.

William Portuese, MD · Answer

A rhinoplasty procedure can accomplish raising the nasal tip. There are many different maneuvers to allow a surgeon to raise the nasal tip such as  shortening the caudal septum, suture techniques applied to the lower lateral cartilages of the tip, dorsal hump reduction, and use of different types of cartilage grafting techniques when necessary. A full set of photographs and a physical exam are required to make a determination about what may be required to rotate the tip.  It's also important not to over rotate the tip. For many examples and more information, please see the video and the link below

Michael Yerukhim, MD · Answer

Thank you for your question. Droopy tip can be a very challenging problem to address. However each nose is different and needs to be evaluated in person. Or at least with photos. The short answer is that a columella strut may be sufficient, but it all depends on how droopy your nose is and how the columella strut is fashioned and placed. Rotating the tip usually improves breathing. Tip and shield grafts will not rotate the tip - they can help project the tip. Seek a surgeon you trust and who is experienced in revision rhinoplasty. Good luck!

Arian Mowlavi, MD, FACS (license on probation) · Answer

Columellar strut grafts are used to project the tip; This is the ideal graft for a droopy tip as you have described; what makes the columellar graft in revision rhinoplasty more complictated that the it needs to be firm so that it can withstand the force required to optimally project the tip; the only firm graft is in the septum and this is usually used up; the only other alternative would be the rib; fortunately, we now have cadaveric grafts donated by organ donors that can be used safely and effectively.

Richard Ellenbogen, MD (retired) · Answer

I would put the  graft at the maxilary spine under the foot processes of the medial crus cartilages, This works well.to raise the tip independently

Richard W. Fleming, MD (retired) · Answer

There are many different techniques to raise the nasal tip depending on the needs of each patient, but a columellar strut is not one of them. A strut is used to strengthen a columella but this alone will not raise the tip.

If a patient wants to raise their nasal tip in revision rhinoplasty, can a columnella strut be sufficient?

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